tinnitus Questions On Back Strain (5295) & Tinnitus

[rway]

I have recently went to DAV help putting in for an increase on my disabilities (Meniere's and Migraines). The DAV personnel saw that I was really depressed and told me that I need to check the possibility of having depression add to my claim as Secondary do to all my disabilities. I went to my primary VA doctor and she agreed and put me on the drug Lamictal and made an appointment with Mental Health. The DAV then filled out my paperwork for an increase in all disabilities with Secondary Depression do to these disabilities. My Questions are.....

Am I going to have a C&P for all of my disabilities? I mainly wanted my Menieres and Migraine ratings increased.

What if they believe my other ratings should be decreased? I have a knee conditon (5257) that was rated 30% which is the max that it can be rated, and I do not want to mess that up.

I also have 10% for a Back Strain (5295) and I have not been able to find the code in the rating schedule of musculoskeletal. Can anyone help me locate the ratings for (5295)?

I have also read in the Hadit forum of Bilateral Tinnitus. In the rating schedule, I can only find a 10% rating for Tinnitus (6260). Is there such a rating of Bilateral Tinnitus?

Thanks for any help!

[Guest rickb54]

First, Let me welcome you to hadit.

There is no Bilateral rating for tinnitus. The va rewrote the rules and the courts agreed with the va, the rating for tinnitus is 10% regardless if one or both ears are involved.

as to the back injury:

Here are the ratings for 5295

5295 Lumbosacral strain:

Severe; with listing of whole spine to opposite side, positive

Goldthwaite's sign, marked limitation of forward bending in

standing position, loss of lateral motion with osteo-

arthritic changes, or narrowing or irregularity of joint

space, or some of the above with abnormal mobility on forced

motion....................................................... 40

With muscle spasm on extreme forward bending, loss of lateral

spine motion, unilateral, in standing position............... 20

With characteristic pain on motion............................ 10

With slight subjective symptoms only.......................... 0

Your question, Will you have c/p exams for all your disabilities? It is hard to say, the va can reopen all of your claims any time that you request a re-evaluation for any one problem. My experience is that they will not, however there is a very good posibility that they may. See below.

Sec. 3.327 Reexaminations.

(a) General. Reexaminations, including periods of hospital

observation, will be requested whenever VA determines there is a need to

verify either the continued existence or the current severity of a

disability. Generally, reexaminations will be required if it is likely

that a disability has improved, or if evidence indicates there has been

a material change in a disability or that the current rating may be

incorrect. Individuals for whom reexaminations have been authorized and

scheduled are required to report for such reexaminations. Paragraphs

and © of this

[[Page 245]]

section provide general guidelines for requesting reexaminations, but

shall not be construed as limiting VA's authority to request

reexaminations, or periods of hospital observation, at any time in order

to ensure that a disability is accurately rated.

(Authority: 38 U.S.C. 501)

Compensation cases--(1) Scheduling reexaminations. Assignment of

a prestabilization rating requires reexamination within the second 6

months period following separation from service. Following initial

Department of Veterans Affairs examination, or any scheduled future or

other examination, reexamination, if in order, will be scheduled within

not less than 2 years nor more than 5 years within the judgment of the

rating board, unless another time period is elsewhere specified.

(2) No periodic future examinations will be requested. In service-

connected cases, no periodic reexamination will be scheduled: (i) When

the disability is established as static;

(ii) When the findings and symptoms are shown by examinations

scheduled in paragraph (2)(i) of this section or other examinations

and hospital reports to have persisted without material improvement for

a period of 5 years or more;

(iii) Where the disability from disease is permanent in character

and of such nature that there is no likelihood of improvement;

(iv) In cases of veterans over 55 years of age, except under unusual

circumstances;

(v) When the rating is a prescribed scheduled minimum rating; or

(vi) Where a combined disability evaluation would not be affected if

the future examination should result in reduced evaluation for one or

more conditions.

© Pension cases. In nonservice-connected cases in which the

permanent total disability has been confirmed by reexamination or by the

history of the case, or with obviously static disabilities, further

reexaminations will not generally be requested. In other cases further

examination will not be requested routinely and will be accomplished

only if considered necessary based upon the particular facts of the

individual case. In the cases of veterans over 55 years of age,

reexamination will be requested only under unusual circumstances.

If they decide to lower a rating they will advise you and you will be able to appeal any decision.The va usually does not reduce compensation base on one evaluation, but again they could. see below

Sec. 3.344 Stabilization of disability evaluations.

(a) Examination reports indicating improvement. Rating agencies will

handle cases affected by change of medical findings or diagnosis, so as

to produce the greatest degree of stability of disability evaluations

consistent with the laws and Department of Veterans Affairs regulations

governing disability compensation and pension. It is essential that the

entire record of examinations and the medical-industrial history be

reviewed to ascertain whether the recent examination is full and

complete, including all special examinations indicated as a result of

general examination and the entire case history. This applies to

treatment of intercurrent diseases and exacerbations, including hospital

reports, bedside examinations, examinations by designated physicians,

and examinations in the absence of, or without taking full advantage of,

laboratory facilities and the cooperation of specialists in related

lines. Examinations less full and complete than those on which payments

were authorized or continued will not be used as a basis of reduction.

Ratings on account of diseases subject to temporary or episodic

improvement, e.g., manic depressive or other psychotic reaction,

epilepsy, psychoneurotic reaction, arteriosclerotic heart disease,

bronchial asthma, gastric or duodenal ulcer, many skin diseases, etc.,

will not be reduced on any one examination, except in those instances

where all the evidence of record clearly warrants the conclusion that

sustained improvement has been demonstrated. Ratings on account of

diseases which become comparatively symptom free (findings absent) after

prolonged rest, e.g. residuals of phlebitis, arteriosclerotic heart

disease,

[[Page 250]]

etc., will not be reduced on examinations reflecting the results of bed

rest. Moreover, though material improvement in the physical or mental

condition is clearly reflected the rating agency will consider whether

the evidence makes it reasonably certain that the improvement will be

maintained under the ordinary conditions of life. When syphilis of the

central nervous system or alcoholic deterioration is diagnosed following

a long prior history of psychosis, psychoneurosis, epilepsy, or the

like, it is rarely possible to exclude persistence, in masked form, of

the preceding innocently acquired manifestations. Rating boards

encountering a change of diagnosis will exercise caution in the

determination as to whether a change in diagnosis represents no more

than a progression of an earlier diagnosis, an error in prior diagnosis

or possibly a disease entity independent of the service-connected

disability. When the new diagnosis reflects mental deficiency or

personality disorder only, the possibility of only temporary remission

of a super-imposed psychiatric disease will be borne in mind.

Doubtful cases. If doubt remains, after according due

consideration to all the evidence developed by the several items

discussed in paragraph (a) of this section, the rating agency will

continue the rating in effect, citing the former diagnosis with the new

diagnosis in parentheses, and following the appropriate code there will

be added the reference ``Rating continued pending reexamination ------

months from this date, Sec. 3.344.'' The rating agency will determine on

the basis of the facts in each individual case whether 18, 24 or 30

months will be allowed to elapse before the reexamination will be made.

© Disabilities which are likely to improve. The provisions of

paragraphs (a) and of this section apply to ratings which have

continued for long periods at the same level (5 years or more). They do

not apply to disabilities which have not become stabilized and are

likely to improve. Reexaminations disclosing improvement, physical or

mental, in these disabilities will warrant reduction in rating.

Hope this answers your questions

[rway]

Thank you. Yes, you have answered all my questions and have been quite helpful.

This forum is great. I wished it was here back when I retired. I can tell it is helping a lot of Vets. Keep up the great work.

[Vike17]

rway,

Anytime you apply for an increase for a condition , the VA may take a look see at any other service-connected disabilities you may have. I'm not saying it will happen, just saying the VA may do so. This may be the case if you were already scheduled for a re-exam at some point in the future for your sevice-connected disabilities. I really wouldn't woory about too much, especially if your disabilities haven't gotten any better.

The reason why you can't find the codes listed for your back is because those DC's are no longer in use. The DC's Rickb54 posted are the old DC's for the spnie. The VA changed them in September 2002 to eliminate the subjective nature of those criteria i.e. "mild, moderate, and severe." Now the rating criteria (for back strain) is based on actual range of motion. For IVDS the rating is derived from either range of motion or incapacitating eposides, whichever results in the higher evaluation. If the VA decides to re-evaluate your back, you'll be rated either on the old criteria as Rickb54 provided or under the new criteria, whichever one will result in the higher rating. The new Diagnostic Codes (DC) for the spine are 5235 through 5243.

If you have claimed depression as secondary to your sevice-connected disabilities, make sure your shrink states that in her write-ups. The VA will need to see that nexus to grant this on a secondary basis.

I hope this helps!

Vike 17

[sixthscents]

Yeah Vike's dead on... though under IVDS now, periods of incapacitation are taken into consideration as well... such as bedrest/quarters, or restricted activities under doctors care....

[Guest rickb54]

The reason why you can't find the codes listed for your back is because those DC's are no longer in use. The DC's Rickb54 posted are the old DC's for the spnie.

Vike 17

Vike thanks for catching that I had posted an old rating, I don't know how I did that. I'm glad you caught cause I sure don't want to put out any bad information.

The new codes:

The Spine

------------------------------------------------------------------------

Rating

------------------------------------------------------------------------

General Rating Formula for Diseases and Injuries of the Spine

(For diagnostic codes 5235 to 5243 unless 5243 is evaluated

under the Formula for Rating Intervertebral Disc Syndrome Based

on Incapacitating Episodes):

With or without symptoms such as pain (whther or not it

radiates), stiffness, or aching in the area of the spine

affected by residuals of injury or disease

Unfavorable ankylosis of the entire spine................... 100

Unfavorable ankylosis of the entire thoracolumbar spine.... 50

Unfavorable ankylosis of the entire cervical spine; or,

forward flexion of the thoracolumbar spine 30 degrees

or less; or, favorable ankylosis of the entire

thoracolumbar spine.................................... 40

Forward flexion of the cervical spine 15 degrees or

less; or, favorable ankylosis of the entire cervical

spine.................................................. 30

Forward flexion of the thoracolumbar spine greater than

30 degrees but not greater than 60 degrees; or, forward

flexion of the cervical spine greater than 15 degrees

but not greater than 30 degrees; or, the combined range

of motion of the thoracolumbar spine not greater than

120 degrees; or, the combined range of motion of the

cervical spine not greater than 170 degrees; or, muscle

spasm or guarding severe enough to result in an

abnormal gait or abnormal spinal contour such as

scoliosis, reversed lordosis, or abnormal kyphosis..... 20

Forward flexion of the thoracolumbar spine greater than

60 degrees but not greater than 85 degrees; or, forward

flexion of the cervical spine greater than 30 degrees

but not greater than 40 degrees; or, combined range of

motion of the thoracolumbar spine greater than 120

degrees but not greater than 235 degrees; or, combined

range of motion of the cervical spine greater than 170

degrees but not greater than 335 degrees; or, muscle

spasm, guarding, or localized tenderness not resulting

in abnormal gait or abnormal spinal contour; or,

vertebral body fracture with loss of 50 percent or more

of the height.......................................... 10

Note (1): Evaluate any associated objective neurologic

abnormalities, including, but not limited to, bowel or bladder

impairment, separately, under an appropriate diagnostic code.

Note (2): (See also Plate V.) For VA compensation purposes,

normal forward flexion of the cervical spine is zero to 45

degrees, extension is zero to 45 degrees, left and right

lateral flexion are zero to 45 degrees, and left and right

lateral rotation are zero to 80 degrees. Normal forward flexion

of the thoracolumbar spine is zero to 90 degrees, extension is

zero to 30 degrees, left and right lateral flexion are zero to

30 degrees, and left and right lateral rotation are zero to 30

degrees. The combined range of motion refers to the sum of the

range of forward flexion, extension, left and right lateral

flexion, and left and right rotation. The normal combined range

of motion of the cervical spine is 340 degrees and of the

thoracolumbar spine is 240 degrees.The normal ranges of motion

for each component of spinal motion provided in this note are

the maximum that can be used for calculation of the combined

range of motion.

Note (3): In exceptional cases, an examiner may state that

because of age, body habitus, neurologic disease, or other

factors not the result of disease or injury of the spine, the

range of motion of the spine in a particular individual should

be considered normal for that individual, even though it does

not conform to the normal range of motion stated in Note (2).

Provided that the examiner supplies an explanation, the

examiner's assessment that the range of motion is normal for

that individual will be accepted.

Note (4): Round each range of motion measurement to the nearest

five degrees.

Note (5): For VA compensation purposes, unfavorable ankylosis is

a condition in which the entire cervical spine, the entire

thoracolumbar spine, or the entire spine is fixed in flexion or

extension, and the ankylosis results in one or more of the

following: difficulty walking because of a limited line of

vision; restricted opening of the mouth and chewing; breathing

limited to diaphragmatic respiration; gastrointestinal symptoms

due to pressure of the costal margin on the abdomen; dyspnea or

dysphagia; atlantoaxial or cervical subluxation or dislocation;

or neurologic symptoms due to nerve root stretching. Fixation

of a spinal segment in neutral position (zero degrees) always

represents favorable ankylosis.

Note (6): Separately evaluate disability of the thoracolumbar

and cervical spine segments, except when there is unfavorable

ankylosis of both segments, which will be rated as a single

disability.

5235 Vertebral fracture or dislocation

5236 Sacroiliac injury and weakness

5237 Lumbosacral or cervical strain

5238 Spinal stenosis

5239 Spondylolisthesis or segmental instability

5240 Ankylosing spondylitis

5241 Spinal fusion

5242 Degenerative arthritis of the spine (see also diagnostic

code 5003)

5243 Intervertebral disc syndrome

Evaluate intervertebral disc syndrome (preoperatively or

postoperatively) either under the General Rating Formula for

Diseases and Injuries of the Spine or under the Formula for

Rating Intervertebral Disc Syndrome Based on Incapacitating

Episodes, whichever method results in the higher evaluation

when all disabilities are combined under Sec. 4.25.

[[Page 392]]

Formula for Rating Intervertebral Disc Syndrome Based on

Incapacitating Episodes

With incapacitating episodes having a total duration of at least 60

6 weeks during the past 12 months..............................

With incapacitating episodes having a total duration of at least 40

4 weeks but less than 6 weeks during the past 12 months........

With incapacitating episodes having a total duration of at least 20

2 weeks but less than 4 weeks during the past 12 months........

With incapacitating episodes having a total duration of at least 10

one week but less than 2 weeks during the past 12 months.......

------------------------------------------------------------------------

Note (1): For purposes of evaluations under diagnostic code 5243, an

incapacitating episode is a period of acute signs and symptoms due to

intervertebral disc syndrome that requires bed rest prescribed by a

physician and treatment by a physician.

Note (2): If intervertebral disc syndrome is present in more than one

spinal segment, provided that the effects in each spinal segment are

clearly distinct, evaluate each segment on the basis of incapacitating

episodes or under the General Rating Formula for Diseases and Injuries

of the Spine, whichever method results in a higher evaluation for that

segment.

[[Page 393]]

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[sixthscents]

Rick, do you ever sleep?